Bread type intake is associated with lifestyle and diet quality transition among Bedouin Arab adults

The traditionally semi-nomadic Bedouin Arabs in Israel are undergoing urbanisation with concurrent lifestyle changes, including a shift to using unfortified white-flour bread instead of wholewheat bread as the main dietary staple. We explored associations between the transition from wholewheat to white-flour bread and (1) lifestyle factors, (2) overall diet quality, and (3) health status. We conducted a nutrition survey among 451 Bedouin adults, using a modified 24 h recall questionnaire. Bread intake accounted for 32.7% of the total energy intake. Those consuming predominantly white bread (PWB) (n 327) were more likely to be urban (OR 2.79; 95% CI 1.70, 4.58), eating store-bought rather than homemade bread (OR 8.18; 95% CI 4.34, 15.41) and currently dieting (OR 4.67; 95% CI 1.28, 17.11) than those consuming predominantly wholewheat bread (PWWB) (n 124). PWB consumption was associated with a lower intake of dietary fibre (23.3 (SE 0.6) v. 41.8 (SE 1.0) g/d; P≤0.001), a higher intake of saturated fats (26.9 v. 24.6% of total fat; P=0.013) and lower intakes of Fe (11.0 (SE 0.3) v. 16.7 (SE 0.4) mg/d), Mg (262.2 (SE 5.9) v. 490.3 (SE 9.8) mg/d), vitamin E (6.5 (SE 0.2) v. 8.6 (SE 0.3) mg/d) and most B vitamins than PWWB consumption (P,0.001 for all), after adjusting for total energy intake. Among those aged ≥ 40 years, PWB consumption was associated with a 9.85-fold risk (95% CI 2.64, 36.71; P=0.001) of having one or more chronic conditions, as compared with PWWB consumption, after controlling for other risk factors. White bread intake was associated with a less traditional lifestyle and poorer diet quality, and may constitute a useful marker for at-risk subgroups to target for nutritional interventions.